Dr. Ben Bikman

And then lastly, of the primary reasons

fast causes of insulin resistance is too much insulin itself.

So we know in humans, rodents, and cells, I've published my own work on this topic, that too much insulin will result in a resistance to the stimulus.

So too much insulin can cause insulin resistance.

Now, none of those touch on what you had mentioned, which is the ectopic idea.

That idea is very important.

And there's a lot of nuance to it where we have to define the fat, first of all.

And by that, I mean what of the many of the hundreds of thousands of types of molecules that we call a lipid or a fat within a cell, which are the ones that actually matter to insulin resistance.

Some people will think of just triglycerides, which is the main form of storing fat.

And yet triglycerides are totally inert metabolically.

There was a case in point, Brett Goodpaster and David Kelly 30 years ago described this phenomenon of the

the athletes paradox where they noted that in obesity with type 2 diabetes and insulin resistance if you pull a muscle biopsy there's really high levels of fat in the muscle of triglycerides

And they're very insulin resistant.

And so some people would say and did at the time, well, high muscle triglycerides causes insulin resistance.

And yet when they did muscle biopsies from very lean, exceptionally insulin sensitive marathon runners, they had just as much fat in their muscle in the form of triglycerides as the obese type two diabetics did.

And again, they were very insulin sensitive.

So it couldn't be the fat that was being stored in the muscle.

The same could be said of the liver.

If the liver has triglycerides, it's not the triglycerides that are causing insulin resistance.

What is it?